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Clinical Decision Support BlogThu, 28 Dec 2017 22:24:22 +0000enhourly1https://wordpress.org/?v=4.6.1http://blog.pepid.com/wp-content/uploads/2016/08/cropped-PEPIDLogoIcon-32x32.jpghttp://blog.pepid.com
3232Preparing for New Year’s Eve with PEPIDhttp://blog.pepid.com/preparing-new-years-eve-pepid/
http://blog.pepid.com/preparing-new-years-eve-pepid/#respondWed, 27 Dec 2017 18:02:46 +0000http://blog.pepid.com/?p=666The numbers are staggering. According to Mothers Against Drunk Driving (MADD) there are an average of 300,000 drunk driving accidents per day. It’s a problem magnified during the holiday season, capped off by New Year’s Eve. PEPID is here to help you prepare. Here’s a quick refresher for the most common ER visits on January…

The numbers are staggering. According to Mothers Against Drunk Driving (MADD) there are an average of 300,000 drunk driving accidents per day. It’s a problem magnified during the holiday season, capped off by New Year’s Eve.

PEPID is here to help you prepare. Here’s a quick refresher for the most common ER visits on January 1st: motor vehicle accidents and alcohol.

Motor Vehicle Collisions Trauma Overview

This PEPID monograph covers head and spine trauma from a broken windshield, knee and pelvic trauma from hitting the dashboard, lower body crush injuries from rollovers, rib fractures from a broken steering wheel, cervical spine hyperextension injuries from rear-end collisions, as well as injuries associated with seat belts and seat belt trauma.

Alcohol Overconsumption

Drunk Driving Prevention

With the prevalence of taxi apps like Lyft and Uber, paired with public transportation, there’s no excuse for impaired driving. Include these statistics in your patient education resources to help prevent more unnecessary drunk driving deaths. Visit the MADD website for more prevention tips.

]]>http://blog.pepid.com/preparing-new-years-eve-pepid/feed/0You’ll Shoot Your Eye Out! PEPID’s Prognosis for Injured Christmas Charactershttp://blog.pepid.com/pepids-prognosis-for-popular-holiday-movies/
http://blog.pepid.com/pepids-prognosis-for-popular-holiday-movies/#respondFri, 15 Dec 2017 22:28:19 +0000http://blog.pepid.com/?p=545Quick! A young boy is in the ER after shooting his eye out. In the next room, you’ve have a drunk and belligerent mall Santa. Next to him is a pair of burglars known as the Wet Bandits who have a series of serious injuries. Across the hall, you’ve got a green man with multiple heart conditions to…

]]>Quick! A young boy is in the ER after shooting his eye out. In the next room, you’ve have a drunk and belligerent mall Santa. Next to him is a pair of burglars known as the Wet Bandits who have a series of serious injuries. Across the hall, you’ve got a green man with multiple heart conditions to monitor. To top things off, there’s a grown man in another room claiming to be an elf from the North Pole who is eccentric to say the least.

What do you do? These holiday characters need medical help and PEPID is here to answer the call.

Ralphie Shoots His Eye Out

Movie:A Christmas StorySynopsis: Ralphie has his heart set on getting a Red Ryder B.B. Gun for Christmas, but his parent’s – even Santa – said no because “you’ll shoot your eye out, kid!” When he received the B.B. gun on Christmas, he did just that.PEPID Protocol:Globe Injury Treatment

Tongue Stuck to Pole

Movie:A Christmas StorySynopsis: After a triple dog dare, Flick licked a metal pole in freezing temperatures, and now his tongue is stuck and he’s awaiting the arrival of firefighters to remove his tongue from the pole.PEPID Protocol:Tongue Disorders Swelling

Hans Gruber Goes Down

Movie:Die HardSynopsis: After being outwitted by his nemesis John McClain, Hans Gruber falls several stories at the Nakatomi Plaza in Los Angeles.PEPID Protocol:Climbing Falls

Bad Santa Does More Than Milk and Cookies

Movie:Bad SantaSynopsis: Before showing up for his shift, Willie the mall Santa is having difficulty walking, is falling over and destroying holiday displays. He is extremely irritable, has urinated on himself, and chased the Christmas crowd away.PEPID Protocol: Alcohol Toxicity

The Wet Bandits – Harry’s Hand is Red Hot

Movie:Home AloneSynopsis: During at attempted burglary, Harry was met with a series of intricate booby traps, leading to several severe burns. One burn is on his hand after grabbing a red hot door knob. Next, when he opened the door, it triggered a blow torch that targeted his scalp for several seconds.PEPID Protocol: Burns: Major Severity

The Wet Bandits – Marv is Hurting from Head to Toe

Movie:Home AloneSynopsis: During at attempted burglary with his pal Harry, Marv is struck in the face with a falling iron, and, while barefoot, he stepped on several broken ornaments as well as a pretty thick nail.PEPID Prognosis: Orbital Blowout Fracture, Puncture Wound – Foot

The Grinch’s Small Shoes

Movie: The Grinch Who Stole ChristmasSynopsis: The Grinch is in an extremely bad mood, and his caretaker (the narrator) tells us the Grinch’s shoes are two sizes too small.PEPID Protocol:Plantar Fasciitis and Hallux Pain

The Grinch’s Big Heart

Movie: The Grinch Who Stole ChristmasSynopsis: The Grinch suddenly lost his grumps when his heart amazingly grew three sizes on Christmas Day.PEPID Protocol: Hypertrophic Cardiomyopathy

Buddy the Elf Can’t Adjust to His New Life

Movie:ElfSynopsis:Buddy the Elf was raised at the North Pole by Santa Claus, but soon realizes he’s not like the other elves. He heads to New York City to find his true identity, but is having trouble with his new surroundings. He is rebellious and impulsive, is very anxious, shows a lack of concentration, and at times, is depressed.PEPID Protocol: Adjustment Disorder

**This blog post contains images and excerpts of which are not pre-authorized. This material is available for entertainment purposes, as well as to support clinical decision making under Fair Use. All material on this site contains credit links and attributions to sources.**

]]>http://blog.pepid.com/pepids-prognosis-for-popular-holiday-movies/feed/0Preparing for Christmas Catastrophes with PEPIDhttp://blog.pepid.com/christmas-catastrophes-pepid/
http://blog.pepid.com/christmas-catastrophes-pepid/#respondMon, 11 Dec 2017 21:21:21 +0000http://blog.pepid.com/?p=527The holidays can be the most wonderful time of the year, but that’s not always the case. In fact, for some the holiday season could mean it’s time to deck the halls with gauze and band-aids. In 100 hospitals spread throughout the U.S., The Consumer Product Safety Commission (CPSC) documented more than 1,700 Christmas-related injuries…

The holidays can be the most wonderful time of the year, but that’s not always the case. In fact, for some the holiday season could mean it’s time to deck the halls with gauze and band-aids.

In 100 hospitals spread throughout the U.S., The Consumer Product Safety Commission (CPSC) documented more than 1,700 Christmas-related injuries from 2011 to 2015. Check out this chart from qz.com to see what we mean:

These numbers are why we’ve compiled a list of the most common Christmas-related injuries – from falls to swallowed toys – to help you prepare for the inevitable uptick in ER visits for the holidays.

Falls

An estimated 15,000 people reported to the ER after injuries suffered putting up holiday decorations, making it the most frequent holiday injury in 2012. Unfortunately, it’s not only these types of falls we need to worry about. Back in 2015, every kid in America wanted a hoverboard. Not only did the futuristic skateboards spontaneously burst into flames, there were also 70 reported ER visits due to hoverboard-related falls.

Swallowed Toys

There’s a reason certain toys are for ages 3 and up. From 2011-2015, there were 164 reported cases of injected foreign bodies during the holidays. But then again, earlier this year an adult discovered a Playmobil traffic cone had been in his lung for 40 years.

Cuts & Lacerations

Many have suffered bad cuts and lacerations after opening presents with knives, or have stabbed themselves with scissors. There was even one report in 2015 of a man cutting himself after using a chainsaw to trim his tree. On top of that, stepping on broken decorations can also cause some serious damage.

Alcohol Poisoning

Being the life of the party can take its toll. With lots of holiday parties taking place, many have a tendency to overindulge, resulting in alcohol poisoning. Furthermore, things become more complicated when opioids and prescription pills are involved.

Food

Abandoned diets and spoiled food can lead to allergic reactions and anaphylactic shock and the risk of hyperglycemic emergencies. These include diabetic ketoacidosis, hypertension, and hyperglycemia, after one too many Christmas sweet treats.

]]>http://blog.pepid.com/christmas-catastrophes-pepid/feed/0Repercussions of the Wildfires & How to Treat Themhttp://blog.pepid.com/repercussions-wildfires-treat/
http://blog.pepid.com/repercussions-wildfires-treat/#respondFri, 08 Dec 2017 23:20:58 +0000http://blog.pepid.com/?p=550Wildfires are ravaging thousands of acres of land in California. Many displaced victims will be seeking treatment away from home with many problems associated with the fires. Here are the most common health problems emergency departments will see. Click to view the PEPID protocol for each. General Information Structure and Wildland Fires Heat Injuries – Edema, Tetany, Syncope,…

Other

]]>http://blog.pepid.com/repercussions-wildfires-treat/feed/0World AIDS Day: 3 Reasons to be Optimistichttp://blog.pepid.com/world-aids-day/
http://blog.pepid.com/world-aids-day/#respondThu, 30 Nov 2017 23:15:07 +0000http://blog.pepid.com/?p=491World Aids Day is Friday, December 1. It’s a day to bring awareness to HIV/AIDS, a disease that took more than one million lives in 2016 alone. Luckily, we’re closer than ever before to finding a cure. Here are three methods that could hold the keys to curing this horrible disease. The Berlin Patient Revisited…

World Aids Day is Friday, December 1. It’s a day to bring awareness to HIV/AIDS, a disease that took more than one million lives in 2016 alone. Luckily, we’re closer than ever before to finding a cure. Here are three methods that could hold the keys to curing this horrible disease.

The Berlin Patient Revisited – Macaques & Bone Marrow Transplants

You may recall “The Berlin Patient,” also known as Timothy Ray Brown. In 2009, he became the first and only person to be cured of the virus that causes AIDS. In 1995, Brown tested positive for HIV and underwent antiretroviral therapy and experienced few side effects.

Later in 2006, Brown was diagnosed with acute myeloid leukemia (AML), a common blood cancer. Brown underwent a bone marrow transplant after chemotherapy failed in 2007 and miraculously, it was with the AML treatment that Brown’s HIV became undetectable – even without daily medications.

Brown’s doctor, Gero Hϋtter, had his findings published in the New England Journal of Medicine in 2009. Read it here. So far, no other doctor has been able to replicate the results, and other patients have died trying.

Flash forward to November 7, 2017. A new study from Oregon Health and Science University and the Oregon National Primate Research Center successfully performed stem cell transplants in two monkeys – mauritian cynomolgus macaques to be specific. The transplants took place more than a year ago, and still neither monkey has experienced common side effects such as graft-versus-host disease.

It’s an exciting prospect, as researchers have another look into how the “Berlin Patient” was cured. The study’s author, Dr. Jonah B. Sacha, tells Newsweek the findings could mean “we’re going to be able to put people into drug-free remission,” within the next 10 years. Read the full study here.

Vaccination Trials Pick Back Up

Speaking of monkeys, scientists have also been able to provide an effective HIV vaccine to the animals. That means a human vaccination might not be far behind. Pharmaceutical company Sanofi created a three-pronged antibody that protected all eight monkeys against the virus during trials. Human trials are set to start in 2018. Check out the full study here.

Currently, there’s also human trials for an HIV vaccination taking place in South Africa with results expected in 2019. The study, called HVTN 702, looks to enroll 5,400 men and women to receive five injections over a one-year span. All the details are here.

The new study picks up where a 2009 trial in Thailand left off, which found that vaccinations can indeed prevent HIV. In that trial though, the vaccine was only 31 percent effective and wore off over time. Therefore, it could not be approved for the public. More details are here.

Testing Simplified Drug Regimens – One Pill is Better than Three

This past October, another trial found a single-tablet drug regimen for current HIV-1 patients, reducing the overall number of pills a patient has to take.

The trial suggests one pill including darunavir (800 mg), cobicistat (150 mg), emtricitabine (200mg), and tenofovir alafenamide (10 mg) can potentially replace a regimen of three: a boosted protease inhibitor, emtricitabine, and tenofovir disoproxil fumarate. Throughout the 48 weeks of the study, no resistance mutations were found. Read the full study here.

Joseph Eron, MD, Professor of Medicine and Director, Clinical Core, University of North Carolina Center for AIDS Research, Chapel Hill, NC, told Johnson & Johnson, “The findings from the EMERALD study bring us one step closer to being able to offer those who live with HIV and struggle with adherence an option that combines the efficacy and high genetic barrier to resistance of darunavir with the demonstrated safety profile of tenofovir alafenamide into a single tablet.”

In Your PEPID Suite

As a participant of World Aids Day, PEPID has updated its clinical content for HIV/AIDS. We’re now including content cards for both pre-and-post exposure prophylaxis.

]]>http://blog.pepid.com/world-aids-day/feed/0Killing Cancer with CAR-T Cell Therapyhttp://blog.pepid.com/car-t-cell-therapy/
http://blog.pepid.com/car-t-cell-therapy/#respondTue, 28 Nov 2017 23:19:52 +0000http://blog.pepid.com/?p=467There’s a new immunotherapy approach that could change the way cancer is treated in the future. It’s called CAR-T cell therapy and it’s showing promising results in small clinical trials treating children with acute lymphoblastic leukemia (ALL) and adults with advanced lymphomas and blood cancers. Over the course of the next 10 years, CAR-T cell…

There’s a new immunotherapy approach that could change the way cancer is treated in the future. It’s called CAR-T cell therapy and it’s showing promising results in small clinical trials treating children with acute lymphoblastic leukemia (ALL) and adults with advanced lymphomas and blood cancers.

Over the course of the next 10 years, CAR-T cell therapies could change how cancer is treated. Here’s what you need to know:

What is CAR-T Cell Therapy?

Dr. Stephen Forman with City of Hope, a leader in CAR-T cell therapy research, put it simply for ABC news in Los Angeles. “Their sole purpose … is to go into the body, find the cancer, bind to it and kill the cancer cell.”

City of Hope illustrates how this happens in its microscopic look at “CAR-T Cells Destroying Glioblastoma Cells.” In this video, you can see the genetically modified CAR-T cells in action, eating away at cancer cells.

How Do CAR-T Cell Therapies Work?

It starts with genetically modifying a patient’s own T cells to include chimeric antigen receptors (CAR). Blood work is drawn from the patient and T cells are extracted through a blood filtration process called leukapheresis.

The isolated T cells are then sent to a lab to be genetically modified to include CARs. These CAR-T cells are coded to recognize the CD19 antigen found on malignant B cells, as well as other antigens. The entire process takes anywhere from 14 to 21 days.

Meanwhile, the patient will receive lymphodepleting chemotherapy to reduce their leukocyte count. This helps to decrease the risk of the body rejecting the reprogrammed CAR-T cells when delivered back into the bloodstream.

Back in the lab, CAR-T cells undergo expansion and will be quality tested before being sent back to the patient. Once the CAR-T cells are delivered back into the patient’s blood stream, the CAR-T cells essentially hunt down the cancer cells and attach themselves to it, initiating direct cell death.

New Drugs Approved by the FDA

Two drugs that were recently approved by the FDA for CAR-T cell therapies. More are sure to come, as there are currently more than 300 CAR-T trials in progress.

KymriahApproved by the FDA on August 30, 2017, Kymriah (also known as tisagenleclucel) is the first gene-modified cell therapy to be approved in the United States for children and patients up to 25 years old with B-cell precursor lymphoblastic leukemia (ALL) who have not responded well to other treatments. An estimated 15 to 20% of ALL cases don’t respond to other treatments or resurface after initial interventions.

During clinical trials of 63 pediatric and young adult patients with relapsed or refractory B-cell precursor ALL, Kymriah showed an impressive remission rate of 83% within three months of treatment. If treatment with Kymriah fails, patients will not pay the $475,000 price tag.

YescartaApproved on October 18, 2017, a similar gene-alerting drug called Yescarta (also known as axicabtagene) was approved for adult patients with types of large B-cell lymphoma who have not seen successful results with at least two other treatments. It’s also the first-approved gene therapy for certain types of non-Hodgkin lymphoma.

In a clinical trial of more than 100 adults with B-cell lymphoma, Yescarta’s complete remission rate was 51 percent. Yescarta has a lower price tag than Kymriah, priced at $373,000.

Cytokine Release Syndrome & Actemra

Despite successful clinical trials, these new drugs are not perfect. When CAR-T cells activate the immune system against cancer, a large quantity of cytokines are released, which can lead to cytokine release syndrome (CRS). CRS has moderate to severe side effects such as fever, nausea, tachycardia, asthenia, headache, rash, dyspnea, and sometimes death.

During clinical trials, 49% of patients treated with Kymriah suffered from CRS. Therefore, the same day the FDA approved Yescarta, it also approved Actemra (tocilizumab) for new indications to treat patients over the age of two years with life-threatening CRS. According to an FDA press release, “69 percent of patients had complete resolution of CRS within two weeks following one or two doses of Actemra.”

A Bright Future

Despite challenges, researchers are optimistic about these new therapies, with superlatives such as “revolutionary” and “miracle cure” being tossed around. They’ve helped patients like Chuck Fata get a new lease on life. Fata was diagnosed with diffuse large B-cell lymphoma. He received CAR-T treatment after other treatments failed. “I was in remission and back on the road. It was pretty incredible,” Fata told ABC7 in Los Angeles.

]]>http://blog.pepid.com/car-t-cell-therapy/feed/0ASHP’s 75th Anniversary … Will We See You There?http://blog.pepid.com/ashp17/
http://blog.pepid.com/ashp17/#respondMon, 27 Nov 2017 19:50:14 +0000http://blog.pepid.com/?p=479We’re very excited to announce that the PEPID team will be attending the 75th Anniversary ASHP conference. ASHP’s Midyear Clinical Meeting and Exhibition brings in more than 25,000 pharmacy professionals, making it the largest gathering of pharmacy professionals in the world! We couldn’t be more excited! This year, ASHP has pulled out all of the stops. They’re bringing in none other than former…

We’re very excited to announce that the PEPID team will be attending the 75th Anniversary ASHP conference. ASHP’s Midyear Clinical Meeting and Exhibition brings in more than 25,000 pharmacy professionals, making it the largest gathering of pharmacy professionals in the world! We couldn’t be more excited!

This year, ASHP has pulled out all of the stops. They’re bringing in none other than former First Lady Michelle Obama for a moderated conversation. There will also be a big party at Universal Studios! We sure won’t miss that!

Come Say Hi at ASHP See What’s New with PEPID

We’ve been working hard behind the scenes to provide PEPID users with the most up-to-date information needed to treat their patients.

Come see the PEPID team at BOOTH 621 in the Exhibit Hall throughout the conference for an exclusive look at the upcoming release of our Drug Interactions Checker, which will include predictive drug-gene interactions! Already in our suites, we have updated monographs on revolutionary new CAR-T cell therapies.

Stop by and get your complementary access to our new Drug Interactions Checker as soon as it is released. Oh yea, and did we mention we’ll be giving away Kindle Fire tablets and Echo Dots too? Don’t forget – booth 621!

About Pharmacist Pro

PEPID’s Pharmacist Pro with AHFS suite is the most comprehensive drug information database on the market. With 13,000+ U.S. and Canadian drug trades, generics, over-the-counters, and herbals, pharmacists have quick, easy access to drug information.

]]>http://blog.pepid.com/ashp17/feed/0New Study Could Change the Way Doctors Prescribe Opioids in the ERhttp://blog.pepid.com/opioids-in-the-er/
http://blog.pepid.com/opioids-in-the-er/#respondMon, 20 Nov 2017 15:15:39 +0000http://blog.pepid.com/?p=443Finally, some encouraging news about the opioid crisis. The results of a recent study could lead to a change in the way doctors prescribe opioids for pain in emergency departments. Findings from a randomized clinical trial, authored by Dr. Alex Chang, show that a combination of non-opioid pain relievers, ibuprofen and acetaminophen, are just as…

Finally, some encouraging news about the opioid crisis. The results of a recent study could lead to a change in the way doctors prescribe opioids for pain in emergency departments.

Findings from a randomized clinical trial, authored by Dr. Alex Chang, show that a combination of non-opioid pain relievers, ibuprofen and acetaminophen, are just as effective as a combination of acetaminophen and the opioids oxycodone, hydrocodone, or codeine, in treating patients in the emergency room with acute extremity pain.

“I have treated overdose victims and have spent time talking to heroin addicts during my shifts. I’ve found that many became addicted from prescription opioids, which are sometimes prescribed after an ED visit,” the study’s author, Dr. Alex Chang tells PEPID via email.

“If non-opioids can be used to treat acute extremity pain, then we may be able to prevent some people from becoming addicted to prescription opioids and prevent them from being exposed to opioids in the first place.”

Dr. Chang and his team conducted the trial at two urban Emergency Departments in the Bronx over the course of a little more than a year. It includes 411 ED patients, aged 21 to 64 years, with acute extremity pain. Adverse events were not assessed and patients were randomly assigned to one of four different groups:

A group received 400 mg of ibuprofen and 1000 mg of acetaminophen;

B group received 5 mg of oxycodone and 325 mg of acetaminophen;

C group received 5 mg of hydrocodone and 300 mg of acetaminophen; and

D group received 30 mg of codeine and 300 mg of acetaminophen.

Using the Numeric Rating Scale (NRS), patients rated their pain two hours after intervention.

The study concludes that for patients in the ED with acute extremity pain, there are no significant clinical differences in pain reduction between single-dose treatments with ibuprofen and acetaminophen versus combinations with three different opioid and acetaminophen analgesics. According to the study, “the predefined minimum clinically important difference is 1.3 on the NRS.”

The Study’s Limitations

While the findings are overall very encouraging, it’s important to understand that this study is limited to a single dose of analgesic in ED patients with acute extremity pain.

“We can’t generalize the results to the outpatient setting, to chronic pain, to repeated treatment at home, or to pain in other body parts, such as the abdomen. Although we found no difference in pain relief at two hours, it’s important to know that this was on average, and that any individual patients might receive better pain relief from a particular analgesic. Just because something is true in general doesn’t mean it is true for everyone,” says Dr. Chang.

Dr. Chang also warns that “we need to be careful and not swing the pendulum too far in the other direction,” so that arbitrary regulatory restrictions are not imposed to prevent patients who need opioids from receiving them.

What’s Next?

There’s a lot more work in Dr. Chang’s foreseeable future. “A good researcher uses the data from prior studies to inform the next study. That is what this study has done for me. I plan to follow patients after ED discharge now that I know non-opioids provide comparable pain relief while in the ED.” He also plans to study side effects, as they will have a significant impact on which analgesic physicians prescribe.

In the meantime, Dr. Chang hopes the study sparks meaningful conversations between patient and physician in order to provide adequate pain management without opioids.

“By demonstrating to both patients and physicians that a combination of non-opioid provides pain relief on par with opioids to patients with acute extremity pain, it’s likely the physician will be more inclined not to prescribe an opioid upon discharge and the patient will be more accepting of a non-opioid upon discharge.”

About PEPID

Want to know more about current drugs on the market today? PEPID’s Pharmacist Pro is the most extensive medication information database available. Our comprehensive drug database contains both U.S. and Canadian drug names, generics, over-the-counters, herbals and foods. To learn more about PEPID, visit our home page, watch our overview video, or call us at 602-296-3443.

]]>http://blog.pepid.com/opioids-in-the-er/feed/05 Ways to Help Patients Quit Smokinghttp://blog.pepid.com/5-ways-to-help-patients-quit-smoking/
http://blog.pepid.com/5-ways-to-help-patients-quit-smoking/#respondTue, 14 Nov 2017 12:00:12 +0000http://blog.pepid.com/?p=410An estimated 480,000 Americans die each year from issues associated with smoking cigarettes. According to the CDC, tobacco use is the single largest preventable cause of death in the United States. Even worse, these illnesses cost more than $300 billion each year – $170 billion in medical care and $156 billion lost in productivity. Quitting reduces…

An estimated 480,000 Americans die each year from issues associated with smoking cigarettes. According to the CDC, tobacco use is the single largest preventable cause of death in the United States. Even worse, these illnesses cost more than $300 billion each year – $170 billion in medical care and $156 billion lost in productivity.

Quitting reduces the development of atherosclerosis and lowers the incidence of initial and recurrent myocardial infarction, thrombosis, cardiac arrhythmia, and death from cardiovascular causes. Despite these benefits, many struggle to quit because smoking is a complex behavioral activity seldom cured by simple interventions.

Plus, there are some unpleasant withdrawal symptoms that can last up to six weeks. These include cravings, hunger, weight gain, insomnia, dizziness, constipation, chest pains, and irritability. To top things off, the chance of relapse is great, and no single smoking cessation tool is effective for all smokers.

Luckily, there are a number of different ways you can help patients quit, and quit for good.

Physician Intervention + Counseling

Studies have shown that just three minutes of cessation counseling from a physician improves the chances of quitting. Physician intervention begins with routine assessment of smoking status for all patients and includes the 5 A’s for cessation:

Ask the patient about smoking status at every visit.

Advise the patient to stop smoking.

Assess the patient’s willingness to quit.

Assist the patient by setting a date to quit smoking, providing self-help materials, and recommending the use of pharmacologic agents.

Arrange for follow-up visits, preferably within the first week.

For those who aren’t ready to quit just yet, the 5 R’s for motivational intervention are recommended for discussion: Relevance, Risks, Rewards, Roadblocks, and Repetition.

Suggest New Ways to Deal with Stress

During discussions with patients, you may find stress is one of the underlying reasons your patient smokes. Many patients are conscious of the relationship with weight gain and smoking, too. Suggesting alternative ways to deal with stress and to counterbalance weight gain can enable patients to change their behaviors.

Tell Patients Their Lung Age

It’s long been suspected that presenting smokers with evidence of tobacco’s harmful effect on their bodies – biomarkers – might encourage them to stop. In addition to presenting statistics to scare patients straight, a spirometry can be performed on patients who smoke – even if they’re asymptomatic. This will show them their lung age, which is the average age of a nonsmoker with a forced expiratory volume at 1 second (FEV1) equal to theirs.

Anti-depressants

The only FDA- approved anti-depressant to help with smoking cessation is Bupropion, also known as Zyban. Initiated while the patient is still smoking, Bupropion acts as a nicotine antagonist, and is often used to treat major depressive disorder and seasonal affective disorder by increasing brain levels of dopamine and norepinephrine.

In addition, another option is Varenicline (CHANTIX), a partial agonist at the a4ß2 nicotinic acetylcholine receptor, that aids smoking cessation by relieving nicotine withdrawal symptoms. With Varenicline, the patient will need to set a quit date and start Varenicline a week prior.

Nicotine Replacement Therapy (NRT)

Nicotine replacement therapies, such as gum, patches and nasal spray increase quit rates. They reduce withdrawal symptoms by partially replacing nicotine in the blood. However, one is not proven to be better than their counterparts.

As a result, encourage a combination of treatments if the patient is unable to quit using a single form of pharmacotherapy. Furthermore, the choice of which form to use should also reflect patient needs, tolerability and cost considerations.

Bonus: What Not to Do

The use of e-cigarettes is growing in popularity among smokers who want to quit, however, these devices are unregulated, of unknown safety and may not benefit in quitting smoking.

Anxiolytics, silver acetate, Nicobrevin, lobeline, or naltrexone have yet to be proven effective tools for smoking cessation. However, therapies such as acupuncture, hypnosis, print-based educational handouts, and financial incentive-based programs are significantly better than no intervention at all.

]]>http://blog.pepid.com/5-ways-to-help-patients-quit-smoking/feed/0PEPID Profiles: Saving Lives with Larissa Braun, RN, BSNhttp://blog.pepid.com/pepid-profiles-larissa-braun/
http://blog.pepid.com/pepid-profiles-larissa-braun/#commentsMon, 06 Nov 2017 12:00:44 +0000http://blog.pepid.com/?p=353Listening to her mother’s stories about being air ambulance paramedic, Larissa Braun knew she wanted to be a nurse at an early age. Fueled by adrenaline, she knew she was meant for intensive care medicine, and now she thrives in public health. ­­ Starting in 2011, Braun frequently traveled to Haiti to work for Grace…

Listening to her mother’s stories about being air ambulance paramedic, Larissa Braun knew she wanted to be a nurse at an early age. Fueled by adrenaline, she knew she was meant for intensive care medicine, and now she thrives in public health.

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Starting in 2011, Braun frequently traveled to Haiti to work for Grace So Amazing Ministries in a malnutrition infant rescue center. There she helped provide care for extremely malnourished, impoverished, and sometimes HIV positive children.

One of these children is Abi. The 10-month old baby girl was taken to the center weighing only eight pounds and believed to be HIV positive. Today, the now two-year old weighs a little more than 20 pounds and is doing great.

“It was a whole new world of medicine to me because she’s tiny first of all and is so susceptible to infections and different things. It was so far out of my comfort zone,” Braun says.

Braun to the Rescue in Haiti

“It was terrifying,” Braun tells us, as she shares the story of one of her most memorable patients, Bernard. “We had a child who fell about the height of three stories down a mountain and suffered a head injury. He was brought to the local emergency department and they couldn’t do anything for him because they didn’t have a neurologist.”

With the nearest neurologist hours away and costing thousands of dollars to see, two things the boy did not have, he was taken instead to Braun’s center. “I was terrified because I’m not a neurologist by any means. I did not know what to do,” she says.

Now completely out her comfort zone, Braun had luckily brought some comfort from home with her. She turned to her cellphone, complete with PEPID’s RN Pro.

“In that situation, I would frequently pull out PEPID and say ‘OK, increase intracranial pressure’ and ‘this is what we need to be looking for. This is why we’re watching him so closely. This is what we can expect to happen.’”

The team managed to save the boy’s life, and amazingly, after months of treatment and help from Braun, the boy learned to walk and talk again. “He’s 100% fine now, which is absolutely amazing. It was just phenomenal,” she says.

Facing More New Challenges in Uganda

Now, as Medical Director for Amazima Ministries in Uganda, Africa, Braun oversees two clinics that provide medical care to extremely vulnerable children that would otherwise not have access to any health care. The clinic provides HIV testing, malaria treatment and also assists with malnutrition within the HIV community.

With the bulk of her experience in cardiac units, the ICU, and emergency departments in Canada, once again, the challenges presented in Uganda are completely different from what Braun is used to.

For example, many drugs in Uganda come from places like China, India and other parts of Europe. “All of these drugs are new to me,” she says. “I am always using PEPID to look up medications and treatments for diseases. A lot of physicians here, their education standards aren’t nearly up to what ours would be. That hesitancy to always believe what’s recommended causes you to research. It causes you to make sure that what you’re doing is right,” Braun says.

Better yet, because PEPID doesn’t require an internet connection, Braun knows she has a reliable clinical decision support tool, no matter where on Earth she is. “That’s one of my favorite things. In a community setting, I can pull up PEPID and know it will work when I have no service.”

Thank You, Larissa

It’s amazing what Larissa Braun has been able to accomplish in such a relatively short nursing career. She’s helped so many, and from the sounds of it does not plan to stop anytime soon.

No matter what challenges Braun will face in the future, PEPID is very proud to assist her with her life-saving work. Thank you, Larissa, for everything you do.